Provider First Line Business Practice Location Address:
139 W 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-4970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-402-7298
Provider Business Practice Location Address Fax Number:
252-940-7261
Provider Enumeration Date:
02/10/2010